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............... ...... --------------- <br /> BUILDING PERMIT APPLICATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209)468-3121 <br /> INSPECTION REQUEST-24 HOUR RECORDER:(209)468-3165 <br /> THEAPPQ1CATfQN MUST BECOIAP4ETELY FILLED OUT BYTHE APPLICANT INA.PPLY'FQW' ..--: <br /> 3, <br /> _�ORDER10 , <br /> 1:114 N RMIT: S. <br /> Scope of Work: A/ vc <br /> el', <br /> Project Address: L-1'I(,) 'Rt� Cts+CV1 <br /> 1 7,/ C9 <br /> Project Valuation: Contact E-mail: <br /> OWNERNAM-E:AND ADDRESS: :. . .AP.P I LiC.ANT N.AME AND ADDRE53.: <br /> Name, Name: <br /> Address: Address: C) - -tv k --f 3 <br /> City: 6on State: <A City: <br /> I State: <br /> ZIP: Ph#(207) 3.70 ZIP:- 9,26 <br /> CONTRAGTORINF6RM : JON. <br /> Ph#( <br /> Lic. No: Company Name: <br /> Address: St: ZIP: <br /> DESIGNER INFORMATION Ph#( <br /> Lic.No: Company Name: 1 1 -7 <br /> Addross:3aSc? LV11,4 jyn� r- * City: St: ZIP:0 <br /> pk3 <br /> LENDING AGENCY Ph#( 1077 A G) <br /> Company Name: <br /> Address: City: St: ZIP: <br /> �,- <br /> Permit will be issued to an"Owner-Builder" Yes No © OFFICIAL USE ONLY, <br /> If yes, a completed Owner-Builder Verification Form must Identification Number: <br /> be signed and submitted along with copy of the owner's <br /> -idantificado"dortoissuance- "ha-building-pormit <br /> DECLARAI;ION BY CONSTRUCTION PERMITAPPLICANT <br /> By my signature below, I certify to one of the following: <br /> I am [] a California licensed contractor or M-the property owner or El authorized to act on the property owner's <br /> behalf(requires written approval and Owner/Builder Verification Form signed and submitted). <br /> I have read this construction permit application and the information I have provided is correct. <br /> I agree to comply with all applicable county ordinances and state laws relating to building construction. I authorize <br /> representatives of this city or county to enter theabove-identified property for inspection purposes. <br /> Applicant's Slanatu Date A-2�- <br /> For your convenle e checklists detailing any additional submittal requirements for various building permit types <br /> are available at the Building Division counter. Demolition permit and mobile home on foundation require check- <br /> list. <br /> FAApplication Forms&Handou(MANL)OUTS\BuildingPermit Application.dooPago i of 2 <br /> (Revised(07-08-10) <br />